-Generally dialysis is initiated when the pt uremia can no longer be adequately managed conservatively or when GFR is less than 15 mL/min. -Certain uremic complications including encephalopathy, neuropathies, uncontrolled hyperkalemia, pericarditis and accelerated HTN indicate a need for immediate dialysis

-Abdominal pain: Common complication. Slowing down infusion rate can often correct the problem.

-Outflow problems: If outflow is less than 80% of inflow check for a kink in the tubing. Sometimes evacuation of the bowel will correct the outflow decrease.

-Increased abd pressure: R/T hernias or lower back problems

-Bleeding: Effluent drainage after the first few exchanges may be pink or slightly bloody this is normal. If there is bloody effluent over several days or new apperance of blood it may indicate intraperitoneal bleeding.

-Pulmonary Complications: Atelectasis, pnemonia, and bronchitis may occur from upward displacement of the diaphragm decreasing lung expansion. HOB elevated and positioning may help.

-Protein loss: The periotoneal membrane is permeable to plasma proteins, amino acids and polypeptides. Can lose as much as 5-15g.daywhile on dialysis

-CHO & Lipid abnormalities: Dialysate glucose is absorbed via the peritoneum and may be as much as 100-150g/day. This causes increase in insulin production which stimulates the liver to excrete triglycerides.

-Encapsulating Sclerosing Peritonitis and loss of utrafiltration: the development of a thick fibrous membrane that surrounds and compresses the bowel for unknown reasons.